Consumer Reports gives clear advice on glaucoma, cataracts, and macular degeneration

May 11, 2015

Cataracts

The only way to cure cataracts­—a clouding of the lens of the eye that impairs vision­—is with surgery to replace the bad lens with an artificial one. Though the procedure is very safe and effective, some doctors recommend needless tests or push newer types of lenses that pose risks.

Skip unneeded presurgery tests

Cataract surgery, usually performed as an outpatient procedure, requires only a local anesthetic to numb your eye. Research shows that for most people the only pre-op requirements are that you be free of infection and have normal blood pressure and heart rate. Yet many doctors routinely order other tests, including blood counts and electrocardiograms, as would be necessary before a major procedure. That’s overkill, according to the American Academy of Ophthalmology (AAO). Those tests can come with high co-pays and lead to false alarms that may delay surgery or force you to undergo additional tests, such as a chest X-ray or ultrasound. So ask whether your doctor plans to recommend such tests and, if so, whether you can skip them.

Be wary of premium lenses

In standard cataract surgery, doctors remove the clouded lens and replace it with an artificial, monofocal lens, which provides clear images at either near or far vision. There are multifocal lenses that do both, so you don’t also have to wear glasses.

But multifocal lenses cost up to $4,000—and usually aren’t covered by insurance. More worrisome, a 2012 review found that while the lenses provided better near vision, they also produced more complaints of halos and glare. Other research shows that people with multifocal lenses are also more likely to need repeat surgery.

One time you might consider a premium intraocular lens: if you have an astigmatism, or an irregularly shaped cornea. Special lenses, called toric lenses, can correct that problem, says David Sholiton, M.D., an ophthalmologist at the Cleveland Clinic. And studies reveal that most people who get them are satisfied. But you will probably have to pay $1,000 or more out of your own pocket, because insurance rarely covers them.

Glaucoma

More than 2.2 million Americans have glaucoma, but only half know it. That makes screening important. Treatment is key, too, because glaucoma can lead to permanent vision loss. But treatment, which often requires several different daily eyedrops, can be expensive and complicated.

Get the right tests

Glaucoma often goes undiagnosed because it causes no symptoms until vision declines, at which point treatment no longer helps. So people ages 40 to 60 should consider being examined by an ophthalmologist or optometrist every three to five years; those over 60 need an eye exam every one to two years.

Know you may need more than one test

Though many eye doctors screen for the disease with tonometry—a test that measures eye pressure—that’s not enough. Relying only on intraocular pressure when screening for glaucoma could miss up to half of all cases, research suggests, says San Francisco ophthalmol­ogist Andrew Iwach, M.D., a spokesman for the AAO. So the exam should also include an ophthalmoscopy, which involves examining your optic nerve. If you have elevated eye pressure but no other signs of glaucoma, you may not need to start treatment, which can be expensive. Instead, your doctor might screen you more often.

Go for generics

The most common treatment for glaucoma is eyedrops known as prostaglandin analogs (PGAs), which lower eye pressure. Generic versions of most of those drugs are much cheaper than the brand-name versions. And per­haps because of the lower cost, patients taking them tend to do a better job of using the drops on schedule, which is important, according to an April 2015 study in the journal Ophthalmology.

Know you may need more than one drug

Many people need several drugs to control glaucoma, which usually means adding a beta-blocker drop. In that case, ask your doctor about drugs that combine medications, minimizing the number of drops.

Use proper eyedrop technique

Tilt your head back and pull down the lower lid with your finger to form a pocket. Hold the dropper tip close to the eye without touching it, and squeeze one drop into the pocket. Close your eye for 2 to 3 minutes, tip your head down, and gently press on the inner corner of the eye. Try not to blink. If you need more than one drop in the same eye, wait at least 5 minutes between drops to let the first drop absorb.

Macular degeneration

Age-related macular degeneration, the leading cause of vision loss in the U.S. for people 50 and older, damages the macula, the small area near the center of your retina, causing vision loss in the center of your visual field. The advanced disease comes in two main forms: dry AMD, the more common variety, which is treated mainly with dietary supplements; and wet AMD, the more serious form, which requires monthly injections from an ophthalmologist with one of three drugs. There are controversies about both the supplements and the drugs.

Get the right supplement

Research funded by the National Institutes of Health has shown that a specific blend of vitamins and minerals known as AREDS—vitamins C and E, plus copper, lutein, zeaxanthin, and zinc—cuts the risk by about 25 percent that dry AMD will progress. “It’s really the only treatment,” says Neil Bress­ler, M.D., chief of the retina division at Johns Hopkins University in Baltimore.

But not all eye supplements contain the proper formulation. In January 2015 CVS was sued for incorrectly market­-ing its Advanced Eye Health supplement as comparable to the formula used in published studies. And in an analysis of 11 eye-health supplements in the March 2015 issue of Ophthalmology, only four contained the right mix: PreserVision Eye Vitamin AREDS Formula, PreserVision Eye Vitamin Lutein Formula, PreserVision AREDS2 Formula, and ICAPS AREDS.

Be wary if your doctor suggests a genetic test to determine which supplement is best for you. Remember: Those supplements have only been shown to help treat people diagnosed with AMD. Don’t bother taking any supplement with the hope that it will prevent the disease.

Consider inexpensive drugs

Each of the three drugs used to treat wet AMD—aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis)—work equally well in slowing vision loss. But Avastin costs just $50 per month, compared with $2,000 for the others. So experts recommend Avastin as the first choice for most people with wet AMD. But some doctors resist that advice.

First, Avastin is officially approved only as a cancer drug and doesn’t come in appropriate doses for AMD. So doctors need to get the medicine from a compounding pharmacy, which combines, alters, or—in this case—repackages ingredients. That poses some risk of contamination, and there have been reports of people being harmed by bacteria that got into Avastin. So some doctors, especially those without access to a reliable compounding pharmacy, may hesitate to prescribe the drug.

Some other physicians may have a financial reason for skipping Avastin: Medicare reimburses doctors less for it. That might help your doctor’s wallet, but it can hurt yours: People without sup­plemental Medicare may pay up to $400 out of pocket for Lucentis, compared with just $10 for Avastin.

Our advice: Consider Avastin, especially if you don’t have supplemental Medicare coverage. But ask whether your doctor’s compounding pharmacy is accredited by the Pharmacy Compounding Accreditation Board, which means it must adhere to quality standards.

Stanford Researchers Develop Small Retinal Implant That Could Restore Eyesight

May 11, 2015

Patients with macular degeneration and other retinal diseases could soon be helped by a new implant developed by Stanford University researchers. The implant is smaller and offers vision five times better than existing devices.

Researchers tested the implants in rats and found it provided functional vision equivalent to 20/250, far better than current implants that provide 20/1,200 vision.

“Based on our current results, we hope that human recipients of this implant will be able to recognize objects and move about,” Stanford electrical engineering Georges Goetz, lead author of the paper, said in a university statement.

retinal implant

According to the study, published in the journal Nature Medicine, the wireless implant is subretinal which means it sits on the outer surface on the retina. It is smaller than other retinal implants and would only require minimally invasive surgery to be inserted in a person’s eyes.

Clinical trials in humans are expected to take place next year in France.

For more info: http://www.nature.com/nm/journal/v21/n5/full/nm.3851.html

http://sanfrancisco.cbslocal.com/2015/04/27/stanford-university-researchers-develop-small-retinal-implant-eyesight-macular-degeneration/


Trade in your Old Magnifier

May 10, 2015

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A Note from Lauren Tappan

May 4, 2015

I have Stargardt’s and know that recent research has shown that people with Stargardt’s have problems digesting and absorbing Vitamin A.

I recently purchased a bottle of saffron 20/20. The Canadian company that produces this supplement suggested that this product might not be the best one for people with Stargardt’s because it has additional Vitamin A supplement included in the product.

So I continue to take pure saffron capsules which I have found to be very helpful. I believe it has helped to improve my reading acuity and overall health. So, I pass this anecdotal information on to our blog readers. Thank you.


Potential Sixth Sense for the Blind

April 17, 2015

When a microstimulator and geomagnetic compass were attached to the brains of blind rats, researchers found that the rodents learned to use new information about their location, and navigate through a maze nearly as well as normally sighted rats.

Japanese experiment suggests a future neuroprosthesis might help blind people walk freely in the world

This discovery suggests that a similar kind of neuroprosthesis for humans might one day help the visually impaired walk freely through the world.

One of the highlights from the study was the details surrounding the remarkable flexibility of the mammalian brain.

“The most remarkable point of this paper is to show the potential, or the latent ability, of the brain,” says Yuji Ikegaya of the University of Tokyo. “That is, we demonstrated that the mammalian brain is flexible even in adulthood — enough to adaptively incorporate a novel, never-experienced, non-inherent modality into the pre-existing information sources.”

Ikegaya went on to explain that the brains of the animals they studied were ready and willing to fill in “the ‘world’ drawn by the five senses” with a new sensory input.

It’s worth noting that it was never the intention of Ikegaya and his colleague Hiroaki Norimoto to restore vision; rather, they wanted to restore the blind rats’ allocentric sense. For those unfamiliar, the allocentric sense is what allows animals and people to recognize the position of their body within the environment. Ikegaya and Norimoto wanted to know what would happen if the animals could “see” a geomagnetic signal. Specifically, would this signal fill in for the animals’ lost sight, and would the animals know what to do with the information?

For more info:  http://www.electronicproducts.com/Biotech/Research/By_attaching_a_geomagnetic_compass_to_the_brain_of_a_blind_rat_rodent_acts_like_it_can_see.aspx


Calcium Supplements Tied to Macular Degeneration

April 11, 2015

Older people who take more than 800 milligrams of calcium a day are almost twice as likely to be diagnosed with age-related macular degeneration (AMD), a condition that causes severevision loss, according to a new study in JAMA Ophthalmology.

The link was found only in people 68 and older.

The research doesn’t prove cause and effect but does promote caution to avoid overdosing calcium supplements.

for more info: http://www.webmd.com/eye-health/macular-degeneration/news/20150410/calcium-supplements-amd


Stem Cells Allow Nearly Blind Patients to See

April 2, 2015

In a report published in the journal Lancet, scientists led by Dr. Robert Lanza, chief scientific officer at Advanced Cell Technology, provide the first evidence that stem cells from human embryos can be a safe and effective source of therapies for two types of eye diseases—age-related macular degeneration, the most common cause of vision loss in people over age 60, and Stargardt’s macular dystrophy, a rarer, inherited condition that can leave patients legally blind and only able to sense hand motions.

The trial is the only one approved by the Food and Drug Administration involving human embryonic stem cells as a treatment. (Another, the first to gain the agency’s approval, involved using human embryonic stem cells to treat spinal cord injury, but was stopped by the company.) Because the stem cells come from unrelated donors, and because they can grow into any of the body’s many cells types, experts have been concerned about their risks, including the possibility of tumors and immune rejection.

For more info:  http://time.com/3507094/stem-cells-eyesight/


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